Addiction Potential of Combustible Menthol Cigarette Alternatives: A Randomized Crossover Trial

Abstract

Introduction: The FDA announced its intention to issue proposed product standards banning menthol as a characterizing flavor in cigarettes and cigars. The public health benefits of these product standards may be attenuated by the role of plausible substitutes in the marketplace. Therefore, the present study examined the addiction potential of plausible combustible menthol alternatives compared to usual brand menthol cigarettes (UBMC). Methods: Eighty adult menthol cigarette smokers completed four visits, smoking their UBMC at the first session and 3 menthol cigarette alternatives in random order at the subsequent visits: 1) a pre-assembled menthol roll-your-own cigarette using menthol pipe tobacco and mentholated cigarette tube (mRYO), 2) a menthol filtered little cigar (mFLC), and 3) a non-menthol cigarette (NMC). Measures of smoking topography, exhaled carbon monoxide (CO), craving and withdrawal, subjective effects, and behavioral economic demand indices were assessed. Results: Compared to UBMC, menthol cigarette alternatives resulted in similar topography and CO exposure but significantly lower levels of positive subjective experience and behavioral economic demand indices. Among the alternative products, participants reported the highest level of positive subjective experience and higher demand for mRYO, compared with mFLC and NMC. Similarly, participants were significantly more likely to want to try again, purchase, and use the mRYO product regularly compared with mFLC and NMC. Conclusions and Relevance: mRYO cigarettes were the most highly rated cigarette alternative among study products, suggesting their potential appeal as a menthol cigarette substitute and needed inclusion of menthol pipe tobacco and cigarette tubes in FDA's proposed ban.

Tobacco control policy and regulation from diverse perspectives and contexts

“…They found mixed potential public health impact, with both the highest proportion of people likely to quit in a full flavoured tobacco and e-cigarette ban, but also the highest proportion of people who currently use flavoured products likely to switch to non-flavoured smoking. Wagener et al 15 examined potential combustible menthol alternatives in the case of a US menthol ban. A preassembled menthol roll-your-own cigarette with menthol pipe tobacco and mentholated cigarette tube was the most preferred product, highlighting the need to include these in the proposed FDA menthol ban.…”